David Gimeno Ruiz de Porras and George Delclos are doing the foundational research to understand what work is like in Central America.

By Kaulie LewisPopulation Health ScholarUniversity of Texas SystemMaster's Student in JournalismUT Austin Moody College of Communication

Surveys of workers’ conditions aren’t a new phenomenon, but until recently, nobody had ever taken a close, comprehensive look at working conditions and their health effects in Central America, even though the region’s employment is growing rapidly in the wake of free trade agreements and an increasingly globalized economy.

That’s where David Gimeno de Porras, Ph.D., and George Delclos, M.D., Ph.D., researchers at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, come in.

In 2011, they began working on the First Central American Survey of Working Conditions and Health (known as ECCTS, by its Spanish acronym), surveying over 12,000 workers across Central America. This work was performed in collaboration with colleagues from University Pompeu Fabra in Barcelona, Spain and SALTRA, a Central American network of research institutes and universities headquartered in Costa Rica at the Universidad Nacional.

Gimeno and Delclos, who are both affiliated with the Southwest Center for Occupational and Environmental Health, are currently working on the administration of the second broad survey of working conditions in the area, II ECCTS, which will interview 9,000 workers in the six Spanish-speaking countries of Central America.

Dr. David Gimeno Ruiz de Porras

“Before the ECCTS, surveillance of these conditions wasn’t non-existent, but for the most part it was unreliable,” said Gimeno, who works at UTHealth School of Public Health in San Antonio. “And there were surveys around Latin America, but nothing like this in Central America. But all the pieces were there, ready for a project like this.”

Taking their cue from existing, ongoing studies — like the European Working Conditions Survey, which has been conducted periodically for over 25 years — the researchers drafted a questionnaire about working conditions, social support systems and workers’ physical health. Then their research team conducted over 2,000 surveys in each of six Spanish-speaking countries in Central America: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama.

“What attracted us was the simplicity of the idea of applying this research tool to resource-poor regions of the world,” said Delclos, who is based at UTHealth School of Public Health’s main campus in Houston. “And even though there were a relatively small number of participants as compared to the total working population, this survey reveals very valuable results about the prevalence of various working and employment conditions, about how workers perceive their health and about the links between the two.”

Dr. George Delclos

One of the most valuable, and unique, aspects of the ECCTS proved to be its inclusion of information about informal workers , who are workers in industries that aren’t taxed or monitored by any government. The jobs these workers fill aren’t illegal or black market, but exist outside official social services and supports.

In the U.S., informal or undocumented workers make up about 5 to 10 percent of the total workforce, although these estimates are likely to be imprecise, Delclos said. But in Central American countries, informal workers account for about 70 percent of total employment on average, and in Honduras, it’s more like 85.

“These are probably the most vulnerable, and often the harshest, working conditions, especially for women and children,” Delclos said. But before the survey he worked to organize, little was really known about exactly what those informal work conditions were, or how they were affecting workers.

Now that researchers have a much wider and more reliable pool of information about informal workers, they can begin to better link those conditions to ongoing health issues. Gimeno has published research about the connection between work conditions and musculoskeletal pain, and the research duo hope their survey can be used in a wide variety of other medical studies.

Delclos offered the example of the kidney disease epidemic in Central America: for 20 years, many young male workers in informal, agricultural labor fields have been developing end stage kidney disease in a phenomenon unique to the region. Though development of the disease has been linked to extended exposure to extreme heat, the number and distribution of people who work under those conditions has been unclear because the existing literature was produced by — and centered on — the sugar cane industry. While the ECCTS can’t clearly establish links between the working conditions it describes and medical conditions like premature end stage kidney disease, it opens the doors to further research.

A sugar cane worker in Costa Rica.

“Maybe we can pick up potential hot spots, other areas where there may be people suffering from this disease but no one has paid attention,” Delclos said. “All of a sudden we can map out the distribution of workers in similar work and environmental conditions, and hopefully we can find them before they reach the end stage of this disease.”

The effects of work conditions on physical health aren’t the only research interest Delclos and Gimeno are pursuing. The pair have recently expanded their survey by developing an additional module of questions about work-related violence, which is an increasingly pressing topic that’s drawing attention both at home and abroad.

For their survey, Gimeno and Delclos defined work-related violence as “any act in the workplace, while commuting, or outside the workplace, related to incidents of force or power inflicted by humans upon each other.” The questions they added to the ECCTS covered physically violent acts as well as threatening behavior, coercion, or work-related self-inflicted harm.

“It’s really any violence that occurs related to work, at the workplace or outside of it,” Gimeno explained. “It may even include domestic violence. If you’re hit by your partner because of the work you do, that could also be work-related violence.”

The Bureau of International Labor Affairs (ILAB) at the U.S. Department of Labor has been particularly interested in the ECCTS and what it could tell them about violence rates, Gimeno and Delclos said. The DOL is responsible for ensuring that foreign governments comply with workers’ rights conditions established in trade agreements, but it has little in the way of independently obtained data on working conditions or work-related violence in the Central American countries included in the survey.

So, recognizing that the ECCTS could offer exactly the kind of independent data they needed, the DOL called the researchers to encourage them to expand their study to work-related violence — and to offer much of the necessary funding for them to do so.

That doesn’t mean the ECCTS findings are only relevant to the countries studied or international trade agreements, however. Workers in the U.S., particularly those who immigrate across the Texas-Mexico border in pursuit of work, or those who work informal jobs in the same region, face conditions similar to those found in the countries Gimeno and Delclos study.

“What we learn there, it may be more concentrated, but there’s already evidence that there’s a lot of relevance to the U.S. as well,” Delclos said.

“And we’re moving south to north in these studies,” Gimeno said. “Maybe we’ll reach the U.S.”